Playgrounds are exciting, fun places for children. They can help to build dexterity, and they are a great place to make friends. Kids are marvelously inventive and use playground equipment in many different ways not intended by the manufacturers.

Each year in the United States, more than 156,000 children under age 14 are treated in hospital emergency rooms for injuries occuring on public playgrounds, according to the Centers for Disease and Prevention (CDC).

There are many ways to prevent these injuries and to lessen the severity of the injuries that do occur.

Types of Playground Injuries

Playground injuries range from bumps, bruises, and cuts to life-threatening injuries like strangulation.

According to the CDC, approximately 45% of playground injuries are severe. These injuries include:

The vast majority of injuries on the playground are connected with climbing equipment and swings.

Falls

Approximately 79% of equipment-related injuries are caused by falls. Most of these injuries are falls to the ground under equipment, rather than falling onto another piece of equipment.

Children fall because they slip, lose their grip, or lose their balance while playing on monkey bars, swings, slides, merry-go-rounds, and seesaws. Often, they'll fall on their outstretched hand trying to protect themselves, and sustain a fracture involving the elbow. This type of elbow fracture (supracondylar fracture of the humerus) is the most common injury that requires a trip to the operating room for treatment.

Often children are hurt not only by the fall, but by being struck by the equipment as they fall. Something as simple as drawstrings from a hooded sweatshirt can catch on a piece of playground equipment and can lead to a fall.

Other injuries include falls that result from being struck by the same equipment the child was playing with, or as a result of being struck with moving equipment.

Slides

Many injuries are also related to slide use.

A 2009 study found a relationship between shinbone (tibia) fractures and young children going down a slide on the lap of an adult. In many of these cases, the child's leg became stuck, but the adult and child could not stop moving down the slide. In other cases, the child's leg became twisted during the ride down.

Other Causes

A smaller number of playground injuries occur on teeter-totters and seesaws.

To lesser degrees, injuries result from contact with sharp edges of equipment; impact with stationary equipment; and falling after being struck with some type of equipment other than what the child was playing on.

Supervision

Close supervision by a responsible adult may be the most important factor in preventing playground injuries.

Age appropriate equipment and carefully designed playground layouts, by themselves, won't be enough to prevent all injuries that may occur. Adults must provide focused supervision. They must instruct children in proper use of the equipment, and monitor and enforce playground rules.

Playground Checkup

Parents, relatives, teachers, babysitters, or anyone who sends or brings children to the playground should periodically inspect the facility for hazards. Report any problems to the proper officials. Don't let your children use that playground until the authorities have completed repairs.

Whether playground injuries are caused by falls or other types of contact, attention to three major factors can help to reduce the incidence of injury: playground surface, playground design, and equipment installation and maintenance.

Playground Surface

The type of surface on the playground is the most important factor in the number and severity of injuries due to falls.

The number and severity of injuries can be reduced by using softer surfaces, such as wood mulch or chips, shredded tires, or sand.

Hard surfaces, such as asphalt and concrete, would result in the most severe injuries and are unsuitable under any playground equipment.

Soil, packed dirt, grass, and turf are not recommended for surfacing, because their ability to absorb shock can be affected greatly by weather conditions and wear.

Playground Design

A well-planned playground should offer activities to encourage the development of perception and physical skills, including running, walking, climbing, dodging, swinging, sliding, throwing, catching, pulling, and pushing.

General guidelines for a well-planned playground include:

Separate areas for active play, such as swinging, and quiet play, such as digging in sandboxes.

Spaces for preschoolers should be located away from areas where older, more active children play.

A "use zone" should be established around equipment, with adequate space for entering and exiting. Open fields should be located so that children can run freely without colliding with other children or equipment.

Zones for popular activities should be separate to avoid overcrowding.

Pathways that link activity areas should provide for easy travel between areas, and unobstructed vision for a child's height.

Sight lines in all playground areas should be clear to allow proper adult supervision.

Equipment Installation and Maintenance

Schools and cities should keep playgrounds in good condition by inspecting and maintaining the equipment throughout the year. Heavy rainfall, snow, temperature extremes and high winds can damage playground equipment. So can heavy use. The most popular equipment might wear out quickly.

Manufacturers' instructions for proper installation and spacing should be followed carefully, including recommendations for maintenance.

Equipment should be inspected regularly to identify any loosening, rust or corrosion, or deterioration from use, rot, insects, or weathering.

No child should use equipment that does not meet U.S. Consumer Product Safety Commission guidelines. A copy of the guidelines is available, free of charge, by writing to U.S. Consumer Product Safety Commission, Washington, D.C. 20207.

Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)

The Pediatric Orthopaedic Society of North America (POSNA) is a group of board eligible/board certified orthopaedic surgeons who have specialized training in the care of children's musculoskeletal health. One of our goals is to continue to be the authoritative source for patients and families on children's orthopaedic conditions. Our Public Education and Media Relations Committee works with the AAOS to develop, review, and update the pediatric topics within OrthoInfo, so we ensure that patients, families and other healthcare professionals have the latest information and practice guidelines at the click of a link.

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.